A recent project by NCQA engaged members of the public, physicians, employers, and health care organizations in determining what consumers want and need to know about physician quality and how the information might best be provided. As highlighted in a report⁽¹⁰⁾ by Donna Pillittere and colleagues, the research indicates that consumers, if given an appropriate frame of reference, are capable of comprehending data on physician performance — a finding that strengthens the case for making such information more broadly available to the public. The results will also inform NCQA's plan to adapt Health Plan Employer Data and Information Set (HEDIS) measures to assess the performance of physicians and physician groups.

NCQA has also compiled a catalogue of available measures of physician performance for use by the Doctor's Office Quality Project, a national demonstration initiative of the federal Centers for Medicare and Medicaid Services. Medicare will eventually build on the work to implement a performance-based reimbursement system.

A great deal of information about physicians' training, affiliations, and quality is already publicly available through the Internet. Yet, as documented in a 2002 Fund report⁽¹¹⁾ by Elliot Stone and the Massachusetts Health Data Consortium, there are significant gaps in the accuracy and completeness of web-based physician directories. Expanding on that work, NCQA convened a national advisory group that developed a set of recommended standards for physician directories. The recommendations were published in the fall of 2003. The Fund is supporting demonstration projects to develop and evaluate the impact of community-level physician directories that follow the recommended standards.

The health care system's capacity to improve care can be enhanced with computer-based tools and other technical support. In 2000, a survey of hospitals by the Health Research and Educational Trust (HRET) produced striking evidence of the need for better medication practices. A follow-up Fund grant enabled HRET and the Institute for Safe Medication Practices (ISMP) to develop Pathways for Medication Safety,⁽¹²⁾ a modular program that assists hospital leaders in identifying error-prone processes and implementing safer procedures. The tools are easy to use and can be put into action immediately. The Pathways program has generated intense interest among state hospital associations and health systems, and project director Lorri Zipperer and colleagues have presented the program at numerous professional meetings and workshops.

University of Colorado researchers Stephen Ross, M.D., and C. T. Lin, M.D., have been studying what happens when patients have access to their medical records. An initial survey of the medical literature revealed that, in the relatively small number of earlier studies involving patient access to traditional paper records, care was often positively affected. Ross and Lin published the results of the literature review in an article⁽¹³⁾ in the Journal of the American Medical Informatics Association. They are now completing work on a randomized trial involving patients with congestive heart failure, some of whom are given access to their electronic medical records and the ability to communicate with their physicians via email.

John Wasson, M.D., of Dartmouth Medical School has continued to disseminate an innovative online survey on health and health care, conducted through the website howsyourhealth.com. The How's Your Health survey was piloted in 2000 in Long Beach, California, where 2,000 respondents participated, and has since been used in Mobile, Alabama, and other communities. This year, the Fund's support enabled the Chicagoland Chamber of Commerce to move forward with a plan to use the survey as the centerpiece of a health awareness campaign in the fall of 2003. Wasson has also published a book on the survey, How's Your Health, America?,⁽¹⁴⁾ with partial support by the Fund.

Finally, authors Sheila Leatherman and Douglas McCarthy, whose Quality of Health Care in the United States: A Chartbook has been the year's most frequently requested and downloaded Fund publication, are now developing specialized chartbooks on the quality of health care for children and the elderly.